Provider Demographics
NPI:1659569218
Name:KENNISON FAMILY FOSTER HOME
Entity Type:Organization
Organization Name:KENNISON FAMILY FOSTER HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:HOME PROVIDER
Authorized Official - Phone:207-527-2405
Mailing Address - Street 1:353 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-4402
Mailing Address - Country:US
Mailing Address - Phone:207-527-2405
Mailing Address - Fax:
Practice Address - Street 1:353 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-4402
Practice Address - Country:US
Practice Address - Phone:207-527-2405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities